Risk of suicide attempt in patients recently diagnosed with mild cognitive impairment or dementia

Abstract

AbstractBackgroundLittle is known about the association between mild cognitive impairment (MCI) and suicide. Most studies have focused on dementia and suicidal behavior, with inconsistent results. Our objective was to (a) examine the association between MCI and dementia diagnoses and suicide attempt and explore potential psychiatric moderators, and (b) assess whether the association differs based on recency of diagnosis.MethodWe conducted a nationwide cohort study that integrated five national databases from the Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services. U.S. veterans aged ≥50 years with MCI diagnoses at baseline (2012‐2013) or prior to baseline (2008‐2011) were propensity‐matched 1:3 with a) patients with dementia diagnoses and b) patients without either diagnosis based on demographics and the Charlson Comorbidity Index (N=147,595). MCI/dementia diagnoses were defined as 'recent' if there were no diagnosis codes prior to baseline. Information on suicide attempts through December 31, 2016 was provided by the National Suicide Prevention Applications Network (SPAN; non‐fatal) and Mortality Data Repository (MDR; fatal).ResultThis study included 21,085 patients with MCI, 63,255 patients with dementia, and 63,255 patients in the propensity‐matched comparison group. Participants had a mean (SD) age of 74.7 (10.3) years, 4,242 (2.9%) were women, and 127,065 (86.1%) were non‐Hispanic White. Exploratory analyses revealed that no psychiatric comorbidity moderated the association between MCI/dementia and suicide attempt. After adjustment for demographics, medical and psychiatric comorbidities, risk of suicide attempt was consistently highest for patients with a recent MCI or dementia diagnosis, with adjusted hazard ratios of 1.73 (95% CI, 1.34‐2.22, P<.001) for recent MCI, and 1.44 (95% CI, 1.17‐1.77, P=.001) for recent dementia. Risk for prior diagnosis was not significant (prior MCI: HR=1.03, 95% CI, 0.78‐1.36, P=.843; prior dementia: HR=1.14, 95% CI, 0.95‐1.36, P=.151).ConclusionOlder adults with recent MCI or dementia diagnoses are at increased risk to attempt suicide. These findings suggest that involvement of supportive services at the time of or soon after diagnoses of MCI or dementia may help mitigate risk of suicide attempts.